Migraines, Headache and Occipital Neuralgia – A Complex Pain Problem
Migraines, occipital neuralgia and other headaches are all a complicated mixture of the multiple causes of head pain. Having “headaches” is not just a simple problem of “take two aspirin and call me in the morning.” Headaches and every other type of head pain are actually a broad spectrum of neurological problems that make up the condition known as Mixed Headache Disorder. It is not unusual for an individual to suffer from two, three or even four different types of headache. It is the identification of these different causes of headache and specific treatments needed to treat these that result in successful migraine management.
Aside from the obvious migraine or tension headache, the next most common headache are known as rebound headaches. Rebound headaches are caused by excessive use of analgesic medications such as aspirin, ibuprofen, Aleve, Excedrin, Goodies Powder or any other medication use to treat acute head pain, including especially any narcotic pain killer. Rebound headache disorder is characterized by – “The more headaches I have, the more medication I take. The more medication I take, the more headaches I have.” It is a viscous cycle, out of control. The only treatment for rebound headaches is to stop taking analgesics and to start on migraine prevention therapy.
Another common, frequently unrecognized headache condition is occipital neuralgia. In this condition, an affected individual suffers from occipital headache – pain in the back of the head. Interestingly however, is that occipital neuralgia can be a frontal headache only. The key in diagnosing this condition is to find tenderness at the base of the skull on either or both sides. This, in combination with a normal neurological exam, is what makes the diagnosis of occipital neuralgia. The most effective treatment for occipital headaches is an occipital nerve block – a simple, in-office procedure usually requiring only one treatment per side.
The concept of suffering from sinus headaches is another problem of fiction overruling fact. The fact is, is that 98% of all sinus headaches are actually migraines or migraine variant headaches. True sinus headaches are almost nonexistent. The confusion exists because common symptoms of migraine include nasal congestion, sinus pressure and feeling of facial swelling. These symptoms are commonly triggered by weather systems, high pollen count or allergies. Patients assume that because of the association of their headaches with the common migraine triggers, that they are suffering from sinus headaches when they are actually having a common migraine attack. It is not uncommon for patients to have taken numerous prescriptions for sinus problems, none of which have helped their “sinus headache” while the few lucky patients have had they correct diagnosis made and are on migraine medications.
The mainstay treatment of migraines is to put patients on adequate preventative therapy. The best migraine prevention therapy is taking certain antidepressants, as this class of medication works better to block migraine than any other. It has nothing to do with their use in treating depression. Topamax and Depakote – both anticonvulsant medications – are FDA approved to prevent migraines. They have the problem of having side effects that patients may not tolerate. Lastly, the best treatment for acute migraines is to take any of the triptan medications – drugs like Imitrex, Maxalt, Treximet, Relpax and others are all in the triptan family.
In summary, if you suffer from any type of recurrent headache problem, get medical treatment from a qualified neurologist and headache specialist. Do not suffer from debilitating headaches as there are excellent therapies available to help you have a better quality of life.